MRA Thought of the Day – Anemia Sequencing: ICD-9-CM vs. ICD-10-10-CM

Anemia Sequencing Scenario:

A 66 year-old patient was diagnosed with carcinoma of the upper third of the esophagus after an admission for workup due to severe fatigue and is undergoing outpatient radiation treatment prior to surgery. However, the patient is admitted today with shortness of breath episodes and was noted to have a HCT of 22. The patient received 3 units of RBCs and was discharged. The physician reports the discharge diagnosis of anemia due to esophageal carcinoma.

Here are my thoughts…

In accordance with current coding guidelines, code 285.22 would be assigned the principal diagnosis resulting in MS-DRG assignment to DRG 812, Red Blood Cell Disorders without MCC. Official ICD-9-CM Guideline Section 1.C.2.c.1 states when an admission/encounter is for management of an anemia associated with a malignancy, and the treatment is only directed for the anemia, the appropriate anemia code is designated as the principal diagnosis followed by the appropriate code for the malignancy.

Makes sense…coders are familiar and comfortable with this guideline as it currently stands. With ICD-10-CM it is only the codes that are changing – the same guidelines apply, correct? NO, the guideline for admission due to cancer related anemia is one official guideline that will be changing come October 1, 2014.

ICD-10-CM Draft Official Guideline Section 1.C.2.c.1 states when an admission/encounter is for management of an anemia associated with a malignancy and the treatment is only directed toward the anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia. The ICD-10-CM tabular does provide guidance for the coder with an instructional note under the anemia code indicating that the neoplasm code is coded first.

So in our patient example above, in FY 2015 the code for the esophageal cancer (C15.3) would be the principal diagnosis followed by the code for the anemia (D63.0). It is important to note with this change in sequencing guidelines there will be a DRG shift of these situations from the anemia DRG into generally higher weighted cancer MS-DRGs.